PMID- 33020465
OWN - NLM
STAT- MEDLINE
DCOM- 20210816
LR  - 20210816
IS  - 2329-0358 (Electronic)
IS  - 1425-9524 (Print)
IS  - 1425-9524 (Linking)
VI  - 25
DP  - 2020 Oct 6
TI  - Acute Rejection and Infectious Complications in ABO- and HLA-Incompatible Kidney 
      Transplantations.
PG  - e927420
LID - 10.12659/AOT.927420 [doi]
AB  - BACKGROUND Patients receiving ABO-incompatible (ABOi) or human leukocyte antigen 
      (HLA)-incompatible (HLAi) kidney transplantation (KT) require potent 
      immunosuppression and are thus at a higher risk of infectious complications. We 
      evaluated the clinical outcomes of KT stratified by ABO and HLA incompatibilities 
      and identified the factors associated with the clinical outcomes. MATERIAL AND 
      METHODS Recipients who underwent living-related KT between 2012 and 2017 were 
      included and classified into 4 groups: ABO-compatible and HLA-compatible 
      (ABOc/HLAc), HLA-incompatible (ABOc/HLAi), ABO-incompatible (ABOi/HLAc), and 
      ABO-incompatible and HLA-incompatible (ABOi/HLAi). Cox proportional hazards 
      regression analyses were carried out to evaluate the risk factors of acute 
      rejection. Out of the 1732 patients who underwent KT, 1190, 131, 358, and 53 were 
      in the ABOc/HLAc, ABOi/HLAc, ABOc/HLAi, and ABOi/HLAi groups, respectively. 
      RESULTS The ABO/HLAi group showed the lowest 5-year graft survival rate (91.7%). 
      Death-censored graft survival was not significantly different among the groups. 
      The mortality rate from infections was significantly higher in the ABOi/HLAi 
      group (7.5%) than the other groups. Antibody-mediated rejection-free graft 
      survival was the lowest in the ABOi/HLAi group, with significant differences 
      compared with the ABOi/HLAc group (P=0.02) and the ABOc/HLAi group (P=0.03). 
      ABOi/HLAi (hazard ratio [HR], 2.63; 95% confidence interval [CI], 1.04-6.65; 
      P<0.01) and combined infection (HR, 1.91; 95% CI, 1.45-2.51; P<0.01) were 
      significant risk factors for acute rejection. CONCLUSIONS Patients with both ABO 
      and HLA incompatibilities showed inferior rates of overall patient and graft 
      survival due to infectious complications. Infection was a prominent risk factor 
      of acute rejection following KT after adjusting for possible confounders 
      including ABO and HLA incompatibility.
FAU - Ko, Youngmin
AU  - Ko Y
AD  - Division of Kidney and Pancreas Transplant Surgery, Department of Surgery, Asan 
      Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
FAU - Kim, Jee Yeon
AU  - Kim JY
AD  - Division of Kidney and Pancreas Transplant Surgery, Department of Surgery, Asan 
      Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
FAU - Kim, Sung-Han
AU  - Kim SH
AD  - Department of Infectious Diseases, Asan Medical Center, University of Ulsan 
      College of Medicine, Seoul, South Korea.
FAU - Kim, Dong Hyun
AU  - Kim DH
AD  - Division of Kidney and Pancreas Transplant Surgery, Department of Surgery, Asan 
      Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
FAU - Lim, Seong Jun
AU  - Lim SJ
AD  - Division of Kidney and Pancreas Transplant Surgery, Department of Surgery, Asan 
      Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
FAU - Shin, Sung
AU  - Shin S
AD  - Division of Kidney and Pancreas Transplant Surgery, Department of Surgery, Asan 
      Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
FAU - Kim, Young Hoon
AU  - Kim YH
AD  - Division of Kidney and Pancreas Transplant Surgery, Department of Surgery, Asan 
      Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
FAU - Jung, Joo Hee
AU  - Jung JH
AD  - Division of Kidney and Pancreas Transplant Surgery, Department of Surgery, Asan 
      Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
FAU - Park, Su-Kil
AU  - Park SK
AD  - Division of Nephrology, Department of Internal Medicine, Asan Medical Center, 
      University of Ulsan College of Medicine, Seoul, South Korea.
FAU - Kwon, Hyunwook
AU  - Kwon H
AD  - Division of Kidney and Pancreas Transplant Surgery, Department of Surgery, Asan 
      Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
FAU - Han, Duck Jong
AU  - Han DJ
AD  - Division of Kidney and Pancreas Transplant Surgery, Department of Surgery, Asan 
      Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
LA  - eng
PT  - Journal Article
DEP - 20201006
PL  - United States
TA  - Ann Transplant
JT  - Annals of transplantation
JID - 9802544
RN  - 0 (ABO Blood-Group System)
RN  - 0 (HLA Antigens)
SB  - IM
MH  - ABO Blood-Group System/*immunology
MH  - Adult
MH  - Blood Group Incompatibility/*immunology/mortality
MH  - Female
MH  - Graft Rejection/*immunology/mortality
MH  - HLA Antigens/*immunology
MH  - Humans
MH  - Infections/*etiology/immunology/mortality
MH  - Kidney Transplantation/*adverse effects/mortality
MH  - Living Donors
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/etiology/immunology/mortality
MH  - Retrospective Studies
MH  - Survival Rate
MH  - Treatment Outcome
PMC - PMC7547531
COIS- Conflict of interest None.
EDAT- 2020/10/07 06:00
MHDA- 2021/08/17 06:00
PMCR- 2020/10/06
CRDT- 2020/10/06 05:27
PHST- 2020/10/06 05:27 [entrez]
PHST- 2020/10/07 06:00 [pubmed]
PHST- 2021/08/17 06:00 [medline]
PHST- 2020/10/06 00:00 [pmc-release]
AID - 927420 [pii]
AID - 10.12659/AOT.927420 [doi]
PST - epublish
SO  - Ann Transplant. 2020 Oct 6;25:e927420. doi: 10.12659/AOT.927420.